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Modern Cardiovascular

Diagnostics and Therapy


- Introduction Lszl Czopf M.D., Ph.D.
Course Leader: Rbert Halmosi M.D., Ph.D.
1st Department of Medicine,
University of Pcs

Non-invasive and Invasive Studies

Probability of coronary artery disease (%)


as a function of age, sex, and complaints
No complaints
Age

Extracardiac
pain

Atypical
angina

Typical angina

Male

Female

Male

Female

Male

Female

Male

Female

30-39

1.9

0.3

5.2

0.8

21.8

4.2

69.7

25.8

40-49

5.5

1.0

14.1

2.8

46.1

13.3

87.3

55.2

50-59

9.7

3.2

21.5

8.4

58.9

32.4

92.0

79.4

60-69

12.3

7.5

28.1

18.6

67.1

54.4

94.3

90.6

Modern Cardiovascular Diagnostics and Therapy

OAENKD
Elective course
Credits: 2
14 lectures, 2x45 minutes each
Tolerated absences: 2 lectures
2 written tests during the semester
mid-semester-grade
Location: Ifjsg str. 13, Entz Bla Clinical
Educational Center, Room K004,
Time: Monday 16:00-17:30

Modern Cardiovascular Diagnostics and Therapy


Introduction. ECG-based examinations (ECG
analysis, Exercise stress testing, Holter
monitoring, Transtelephonic ECG, Heart rate
variability, signal-averaged ECG) (Dr. L. Czopf)
Echocardiography (TTE, TEE, stress echo,
contrast echo, 3D echo) (Dr. T. Habon)

ECG the "golden age"

Holter ECG monitoring

Echocardiography

Modern Cardiovascular Diagnostics and Therapy


Nuclear cardiology (hybrid cardiac imaging,
SPECT, PET) (Prof. Dr. K. Zmb)
Cardiac CT and MRI (Dr. E. Szabados)
Genetics of cardiovascular diseases
(Dr. E. Papp)

Changes in the myocardial perfusion after PCI

Laboratory Diagnostics of Acute Coronary


Syndromes (ACS)

Myoglobin
CPK (CPK-MB), Troponin I or T
GOT
LDH

Modern Cardiovascular Diagnostics and Therapy


Principles of laboratory diagnostics in
cardiology, biomarkers (Dr. R. Halmosi)
Interim exam (ECG analysis) (Dr. R. Halmosi)

Pulmonary embolism. Pulmonary arterial


hypertension (Dr. G. Ksmrky)

Modern Cardiovascular Diagnostics and Therapy


Acute heart failure (Dr. Zs. Mrton)
Actual problems in the treatment of stable
angina pectoris
(Prof. Dr. K. Tth/Dr. P. Kenyeres)
Acute coronary syndromes (Dr. L. Nagy)

Arteficial heart and LVAD

Classic and new risk factors


Minor
Major

male gender
age
high LDL cholesterol level
hypertension
smoking
type 2 diabetes mellitus

low HDL cholesterol level


high triglyceride level
severe obesity
physical inactivity
stress
positive family history

impaired hemorheological parameters


(fibrinogen, (CRP), hct, plasma and whole blood
viscosity, wbc count)

hyperuricemia
hyperhomocysteinemia
microalbuminuria
decreased GFR (chr. renal insufficiency)
oxidative stress, air pollution

"Only half of all vascular diseases can be explained by classic risk factors"

Coronary Artery Disease Related Death in Europe

Antiischemic Drugs
1860: nitrates

1960: beta-blockers
1970: calcium antagonists
platelet inhibitors
1980: ACE-inhibitors
lipid-lowering drugs

2000: ivabradine

1990: ARBs and


metabolic drugs

Acute Coronary Syndromes (ACS)


Mechanism in 90% of the cases: thrombosis on the basis of an
underlying atherosclerotic vascular disease

ST-elevation ACS - ECG

Changing Rules in Antiarrhythmic Therapy

Modern Cardiovascular Diagnostics and Therapy


Emergency treatment of cardiac rhythm
disorders (Prof. Dr. K. Tth)
Treatment of resistant hypertension
(Dr. R. Halmosi)

Modern Cardiovascular Diagnostics and Therapy


Pregnancy and heart disease (Dr. G. Ksmrky)
Role of multicenter clinical studies in the
cardiological diagnostics and therapy
(Dr. T. Habon)
Written test (MCQ) (45 min) (Dr. R. Halmosi)

Possible Combinations of Antihypertensive Agents


Diuretics

AT1-receptor
blockers (ARB)

-blockers

others

Calcium
antagonists

ACE inhibitors

Thank you for your attention!